Is such negativity justified? The media is awash with speculation regarding the future of the NHS and, to some extent, the pessimistic tone is warranted. We cannot hide from the figures – the number of organisations overspending or reporting a deficit has increased since the 2012/13 financial year, with more organisations reporting an actual deficit than planned at the beginning of this financial year and more than a quarter of NHS providers in deficit in 2013/14.

For 2015/16, the outlook doesn't look any brighter – the NHS Financial Temperature Check, carried out by us at the Healthcare Financial Management Association (HFMA), highlighted that only a tenth of provider trusts (12%) are confident that they will achieve their financial targets. Why are confidence levels around NHS finances so low?

Firstly, we are seeing improvements in quality requirements following reports such as the Francis inquiry. These have led to increased levels of staffing, particularly within nursing. Secondly an ageing population is leading to increased levels of activity, putting greater stress upon non-elective care in particular. And thirdly, 4% year-on-year real term funding cuts have forced the NHS to deliver more activity, at a higher quality, for less. Delivering all three together at this kind of level is simply not sustainable and service models will need to therefore change.

Then there is the debate about whether we will see privatisation. To some extent, it already takes place. The most common point of interaction between the public and the health service is at the local pharmacy, where most will pay for medicines over the counter or by prescription. Likewise, most pay for dental treatment even if treated by an NHS dentist and so it is a reasonable assumption to make. Will we start having to pay for more types of NHS services and to what extent may that happen?

The King's Fund's productivity report (released in early May) helps to paint a picture. We have seen an overall growth in the amount we spend on health from around 5.5% of GDP in the mid 1990s to a peak of over 8% in 2009. This has fallen slightly since then, but their report suggests that with NHS England projections of flat cash for the NHS, and reasonable assumptions around forecast GDP growth, we could see our spend on healthcare falling back to around 6% of GDP by 2021, equivalent of 2003's spending levels. This would result in a 25% reduction in available resources for the NHS.

This should come as no surprise, given the frequently quoted £30bn savings requirement for the NHS upon its £110bn budget. It is for these reasons that finance directors are voicing their concerns. Staff have worked hard over the past four years to deliver savings more efficiently and effectively while public finances have been constrained. That challenge is becoming increasingly difficult.

It is clear that we will need to redesign, and adapt, services in order for quality not to be compromised. We know many finance directors are calling for the pace of service transformation to be quickened to help with delivering high quality, safe care in an efficient and appropriate manner. It is unmistakable that the future success of the NHS depends on the clinically led transformation of services, utilising the expertise and skills of NHS finance staff to help this to happen as effectively as possible.

It is also crucial that there is an open and honest debate with politicians, the public, and most importantly patients, about the quality and scope of services that is available to ensure our NHS is fit for the future. Ultimately, there needs to be a clear focus on obtaining the maximum value for every pound spent and available to the NHS.